Together with Montefiore Medical Center and New York-Presbyterian in New York, Brigham Health has formed a Fall TIPS (Tailoring Intervention for Patient Safety) Collaborative. The goal of the collaborative is to spread the Fall TIPS Toolkit to ensure that all patients have access to evidence-based fall prevention care. PACU staff nurse Ginny Ryan, MSN, RN, who also serves as a member of the Falls Committee and Chair of the Nursing Quality Committee, represents BWFH at the Fall TIPS Collaborative.
The Falls TIPS Collaborative is free to join and hospitals that choose to participate receive the Fall TIPS Toolkit, training and implementation materials. Participating hospitals are then asked to submit deidentified data related to engaging patients in the three-step fall prevention process, patient falls and fall-related injuries each month. Ryan says the protocol outlined in the Fall TIPS Toolkit works. “It’s the only information out there that has 10 years of data that shows it decreases patient falls,” she says.
Under the protocol, which is used on every inpatient unit at Brigham and Women’s Hospital, a laminated Fall TIPS poster is placed on the whiteboard in the patient’s room. At change of shift, when the oncoming nurse updates his or her name, the date and the plan of care for the shift on the whiteboard, they also have a conversation with the patient around the Fall TIPS poster so that the nursing staff and the patient understand the safety plan clearly. Ryan explains that engaging the patient is the best way to ensure they stay safe. “If you tell someone not to get out of bed but don’t explain why, the first thing they are going to want to do is get out of bed,” she says.
Here at BWFH, the Fall TIPS posters are currently printed out and given to the patients to read. Ryan, as the Lead Implementer of the BWFH Fall TIPS Practice Change, is working to change that and implement the laminated poster method hospital-wide. “It only takes a minute to do it,” she says. “And it does work, if we stay dedicated to it.”
The Fall TIPS are simple Ryan says. In the PACU, where the team has over 900 days without a patient fall, they have been put to the test. “If you have someone who is medicated—and there isn’t a patient in this hospital who isn’t medicated—you cannot leave them unattended,” says Ryan.
For Ryan, spreading the word is vital. “I just don’t want our patients to fall,” she says. “There is really no reason for any of our patients to fall. We have systems in place for a reason. If everyone is committed to doing it, we shouldn’t have falls.”
To learn more about the Fall TIPS Collaborative, visit falltips.org.
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